Gonorrhea

– An acute, sexually transmitted infection of the epithelium of the genitalia, perianus, and pharynx.

Causes and Incidence

Gonorrhea is caused by Neisseria gonorrhoeae and is the most frequently reported bacterial infection in the United States. The peak incidence occurs between 20 and 24 years of age. Infants born to mothers infected with the disease can contract gonococcal ophthalmia during the passage through the vagina.

Disease Process

After intimate contact, the gonococcus attaches to and penetrates the columnar epithelium, producing a patchy inflammatory response in the submucosa with resultant exudate. In men, affected areas include the urethra, prostate, Littre’s and Cowper’s glands, and seminal vesicles. In women, affected areas include the urethra and cervix and Bartholin’s and Skene’s glands. The rectum, pharynx, and conjunctivae are vulnerable in both sexes. Direct extension of the infection occurs through the lymphatics to the epididymis and fallopian tubes. The inflammatory exudate is replaced by fibroblasts, producing fibrous tissue and strictures of the lumen of the urethra, epididymis, or fallopian tubes.

Symptoms

Male genitalia
Urethral pain; dysuria, purulent discharge; urinary frequency and urgency

Female genitalia
Usually asymptomatic; urinary frequency

Pharynx
Sore throat; dry, red tongue

Perianal
Anal itching, burning, and bleeding; pain on defecation; diarrhea; rectal discharge

Conjunctivae
Purulent discharge

Potential Complications

Complications arise with untreated disease and include pelvic inflammatory disease in women and epididymitis and urethral stricture in men. Both sexes may have disseminated disease, with pustular skin lesions, septicemia, endocarditis, meningitis, and arthritis.

Diagnostic Tests

The primary diagnostic tools are the clinical examination, a history of exposure to an infected partner, and a culture of the exudate that is positive for the organism.

Treatments

Surgery
None.

Drugs
Antiinfective drugs sensitive to the organism, following treatment guidelines of the Centers for Disease Control and Prevention.

General
Instruction about sexually transmitted diseases and the importance of completing all treatment; refraining from sexual activity until free of disease; tracing all potentially exposed.